Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study

Abstract

Children HIV exposed uninfected (CHEU) experience higher morbidity and mortality despite safer breastfeeding and improved maternal health with maternal antiretroviral therapy. We present the first global estimates of the CHEU population (age 0–14 years) describing geographic and temporal trends in HIV high-burden countries. Avenir Health, UNAIDS and partners developed the Spectrum AIDS Impact Module to estimate key HIV epidemic indicators from mathematical models. In 2019 UNAIDS published the estimated number of CHEU age 0–14 years for the period 2000–2018. For six UNAIDS regions and 21 HIV high-burden countries we used 2019 UNAIDS CHEU estimates and 2017 UN Population Division estimates of the number of all children in each region/country to further estimate regional/national CHEU prevalence, regional/national contribution to global CHEU population, proportion of CHEU antiretroviral exposed, and percentage change in CHEU population between 2000–2018. In 2018 there were 14.8 million (lower estimate 11.1 million; upper estimate 18.3 million) CHEU, 90% in sub-Saharan Africa and 5% in Asia and the Pacific. Five countries accounted for 50% of CHEU globally: South Africa (3·5 million; 23·8%), Uganda (1·1 million; 7·5%), Mozambique (1·0 million; 6·6%), Tanzania (0·9 million; 6·1%); and Nigeria (0·9 million; 6·0%). In five southern African countries CHEU prevalence exceeded 15% of the general child population: Eswatini (32·4%), Botswana (27·4%), South Africa (21·6%), Lesotho (21·1%); and Namibia (16·4%). The CHEU population is substantial, requiring a coordinated strategy to reduce HIV exposure in children and ensure optimal health and well-being of CHEU and their families. Going forward, research and programmatic funding investments must be aligned with the geographic distribution of CHEU.